Europe is ageing rapidly. In 2019, slightly more than 20 % of the European population was 65 or older, a nearly 3 % increase since 2009. By 2050, the share of older persons in Europe will reach about 30 % before growth of this demographic levels out. This expansion of the older population is due to advances in medical technology, expanded access to care and changing societal conditions.

Unfortunately, aspects of longer life bring unaddressed and poorly addressed challenges despite generally improved conditions and extended life spans. Many challenges are related to quality of life after retirement age and can be exacerbated by the built environment — homes, hospitals, retirement homes, post offices and grocery stores, among others — which brings this particular challenge into InnoRenew CoE’s area of interest: health and well-being in the built environment.

Challenges faced by older adults span emotional, physical, mental and social domains, and suitable solutions to these challenges require collaboration by many. Policy makers and international organisations provide evolving directives, research funding and guidance towards these solutions. The World Health Organisation (WHO), for example, shifted its focus from Active Ageing to the broader Healthy Ageing. The renewed focus emphasises a wider world view and addresses the needs of older adults in their care. Healthy Ageing guidelines include:

• involving older adults in the definition of their needs
• updating healthcare systems to focus on long-term care that aids and supports people in the ageing process
• creating age-friendly environments (cities, communities, and, by extension, buildings) that combat ageism
• providing inclusive support for ageing persons

There is much to be admired in the WHO’s Healthy Ageing approach, but it is clear that InnoRenew CoE can do the most good by supporting the involvement of older adults in researching the topic and designing solutions.

This approach to user involvement is precisely the approach taken in the Pilots for Healthy and Active Ageing (Pharaon) project. Pharaon is funded by Horizon 2020 as a large-scale piloting project meant demonstrate how existing solutions can be combined to improve the health and well-being of older adults. The project will achieve this by developing simplified systems of technologies to:

• reduce isolation and loneliness
• create better health outcomes in terms of activity, disease, mental health and diet
• increase engagement and social participation
• improve the operational capacity of care facilities

In Slovenia, InnoRenew CoE leads the implementation of a pilot site hosted by Dom upokojencev Izola (DUI). Local partners SenLab and Ericsson Nikola Tesla are key contributors to the technological development of the pilot, while Slovenia’s National Institute for Public Health is involved to bring insight from public health, national actions and other relevant information. The pilot host is a retirement home that houses about 200 older adults at an open campus facility in the coastal town of Izola.

Dom upokojencev Izola. Image: InnoRenew CoE

Residents have varied needs and interests, and prior to the COVID-19 pandemic, Pharaon’s intention was to include them in the design of solutions we would develop and deploy in the home. While COVID-19 hindered our opportunity to involve the residents as fully as we hoped, two scenarios to improve resident experience at the home were developed.

One of the scenarios focused on invisible care. In this scenario, our goal is to improve the quality of data collected about residents and their environment to help care givers provide more personalised care and improve responses to conditions that may lead to harm. By wearing smart watches that monitor biosignals (like heart rate) and activity, onsite care staff have better information about residents, and doctors can provide personalised solutions to each individual. The environment is also monitored — tracking indoor environmental quality measures like relative humidity, carbon dioxide, temperature — to help ensure resident comfort, improve energy efficiency and optimise the use of space.

Figure 1: A goal model diagram expressing the attributes of a goal, “Improve well-being”. Diagrams like this are used to shape technological solutions and ecosystems that are designed to support the expressed emotional needs of potential users. Hearts are desired feelings, clouds are system attributes and boxes are actions within the system.

The second scenario works to implement connectedness and community involvement to reduce isolation and loneliness felt by many older adults. In this case, our goal is to simplify communications with family, friends and caretakers through easy-to-use video calling. In rapid response to the COVID-19 lockdown, when communications became even more sparse than usual, SenLab installed their services to increase connectedness between residents of the retirement home and their families. SenLab also created a new sign-on system to better manage multiple users.

The second scenario will be expanded to include event information and sign-ups for older adults to simplify participation in local events by residents of the home.

Figure 2: A goal model diagram expressing the attributes of a goal, “being part of a community”. Diagrams like this are used to shape technological solutions and ecosystems that are designed to support the expressed emotional needs of potential users. Hearts are desired feelings, clouds are system attributes and boxes are actions within the system.

Behind the scenes, technical solutions have been under development within Pharaon to bring together the many technologies involved in the Slovenian pilot. As this work progresses, the project partners are nearly ready to take first steps towards implementation with pre-validation testing (this is like beta testing the whole system, rather than just the technology). This means a small group will test the solutions provided by the project at each pilot and provide feedback, which can be integrated in the next update to the solution. This approach to user involvement ensures a critical aspect of the project and is part of involving older adults in creating solutions designed for them, a key element of the WHO Healthy Ageing agenda. This phase of testing also includes vigorous checks of the security and privacy measures that protect users from theft, misuse and unwanted use of their information.

Following pre-validation, the project will enter long-term testing of the solutions with more participants. This phase aims to demonstrate the solutions’ value and potential for expansion. The project includes an open call for other solution providers to contribute their technologies to the platform. Funding will be available for small-to-medium enterprises and other providers to modify their technologies and demonstrate them on the Pharaon platform. Both of these activities begin later this year.

Pharaon is contributing more than just technological solutions. One of the outcomes, which I think all participants should take pride in, is the ethics framework developed for large-scale piloting of technologies for older adults. This work is ongoing since the project started and is a foundational element that sets Pharaon apart from other projects. The framework is under peer review for open access publication when the review process is complete.

In addition to the ethics framework, the project reframes data management — often seen as a burden — as an added value of technology solutions. By placing value on user privacy, safety and dignity in the Pharaon approach to data management, the project leads responsible and ethical approaches to data collection and use, particularly related to the personal and health data of older adults.

By the end of the project, we hope to have contributed to making life a little better for older adults by involving them in the process of creating and validating solutions to meet their needs and by handling that great responsibility with the care and dignity it requires.

Dr Michael Burnard
InnoRenew CoE Deputy Director

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Pharaon is funded by the European Commission under grant agreement # 857188. For more information about the project, please visit its website or the CORDIS project page. To learn more about the project at InnoRenew CoE and how the pilot in Slovenia will be implemented, please contact Mike Burnard.